ABSTRACT
The possibility that exposure to environmental tobacco smoke (ETS) might cause the nonsmoker serious health effects first attracted major attention in 1981 when Hirayama, in Japan,
and Trichopoulos, in Greece,
both reported an increased risk of lung cancer related to marriage to a smoker. Since then, numerous individual studies and reviews of the evidence have been conducted. Earlier reviews, in 1986, by the U.S. Surgeon General
and the U.S. National Research Council
concluded that ETS exposure was causally related to lung cancer and was associated with an increased incidence of respiratory symptoms and infections in children and referred to other possible health effects where more data were needed. The claims against ETS widened in 1993, when the U.S. EPA
stated that the association with respiratory symptoms and infections in children was causal, as was that with middle ear disease, exacerbation of asthma and reduced lung function in children, and with respiratory symptoms and reduced lung function in adults. By 1997, the California EPA
extended the list of claimed effects to include cardiovascular disease, nasal sinus cancer, asthma induction in children, Sudden Infant Death Syndrome (SIDS), and reduced birthweight. Similar conclusions were reached in the U.K. in 1998 by the Scientific Committee on Tobacco and Health (SCOTH),
based on a series of papers reviewing the evidence on lung cancer,
ischaemic heart disease,
SIDS,
and middle ear disease
and on respiratory illness, asthma, allergy, and bronchial reactivity in children.
